Andexanet Alfa (Andexxa) therapy can reverse the anticoagulation produced by Apixaban and Rivaroxaban.
Apixaban and Ribaroxaban are direct Factor Xa inhibitors.
Andexanet Alfa is a recombinant protein and modified Factor Xa. It competitively binds direct Factor Xa inhibitors, thereby reducing their effect on native Factor Xa. It also inhibits tissue factor pathway inhibitor (TFPI) which increases the formation of thrombin (TFPI-Xa complexes inactivate Factor VIIa plus tissue factor).
Indications for Andexanet Alfa therapy:
(1) life-threatening or uncontrolled bleeding
Complications:
(1) thrombosis (venous, arterial)
(2) stroke
(3) myocardial infarction
(4) exacerbation of heart failure
(5) cardiogenic shock
(6) acute respiratory failure
(7) infusion reactions
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